Healthcare Provider Details

I. General information

NPI: 1871758110
Provider Name (Legal Business Name): ELIZABETH VICTORIA KOBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4883 MIDDLEDALE RD
LYNDHURST OH
44124-2522
US

IV. Provider business mailing address

4883 MIDDLEDALE ROAD
LYNDHURST OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 216-691-1942
  • Fax:
Mailing address:
  • Phone: 216-691-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35045217
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: